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Article
Kala-azar in Al-Anbar Governorate, Western Iraq
الحمى السوداء في محافظة الانبار, غرب العراق

Author: Zaid R Al-Ani زيد رشيد العاني
Journal: Al- Anbar Medical Journal مجلة الأنبار الطبية ISSN: PISSN: 27066207 / EISSN: 26643154 Year: 2012 Volume: 10 Issue: 1 Pages: 41-49
Publisher: University of Anbar جامعة الانبار

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Abstract

Objectives : To study the clinical presentation, epidemiology, and the therapeutic response of visceral leishmaniasis (Kala-azar) in Al-Anbar Governorate, western Iraq.Methods : All cases suspected of Kala-azar admitted to AL-Ramadi Maternity and Children Hospital from the 1stof November 2001 to the 1stof April 2002 were investigated to look for Kala-azar disease. The diagnosis depended on the clinical presentation, immunofluorescent antibody test (IFAT) and the bone marrow examination (BM) test. The collected data includes the patient’s name, age, sex, residence, presence of water irrigation areas, sand flies (Hermes), dogs & Jackals, and the poultry farms in their residence areas. Data was analyzed and compared with other studies. Results : The majority (75%) of the cases were found under 2 years age, more in males than females, and in rural than urban areas. More than 68% of the recorded cases were from Al-Fallujah district peripheries. The major presenting clinical manifestations were; fever (100%), hepatosplenomegaly (100%), anemia (96.9%), abdominal distention and anorexia (84.4%). The IFAT test results were positive in 93.8% and the BM examination in 51.1% of the studied cases. All cases (except one) responded to Pentostam (Sodium Stibogluconate) treatment in a dose of 15mg/kg/day for 21 days.Conclusion : Kala-azar was found as a public health problem in Al-Fallujah and Al-Ramadi, the largest two districts of Al-Anbar governorate, affecting mainly the infants and children below 3 years age. The use of insecticides, Larvicides and reservoir control, the use of fine window sieves, and the medico-social education about the mode of transmission and role of sand flies, Jackals, dogs, slaughters and poultry farms in the transmission of the disease and their control are important measures for the reduction of the prevalence of this treatable morbid and mortal disease.

الأهداف: دراسة الخصائص الوبائية والعلامات السريرية والاستجابة الدوائية لمرض الحمى السوداء في محافظه الانبار. الطرق: كافه المرضى المشتبه بإصابتهم بالحمى السوداء والذين دخلوا مستشفى الرمادي للنسائية والأطفال للفترة من الأول من شهر تشرين الثاني 2001ولغاية الأول من شهر نيسان 2002 أجريت لهم تحاليل عامه والتحليل المصلي (ايفات) ورشف نقي العظام لتشخيص المرض. المعلومات التي جمعت تشتمل اسم الطفل وعمره وجنسه ومحل السكن للعائلة ونوع مياه الشرب في منطقه السكن وهل توجد الكلاب السائبة وابن آوى ومناطق اروائية وحقول الدواجن ومجازر قريبه لذبح الخراف والدواجن. المعلومات التي جمعت تم تحليلها ومقارنتها مع نتائج البحوث الأخرى.النتائج: أظهرت النتائج أن %75 من حالات الحمى السوداء كانت بين الأطفال الرضع ودون سن السنتين, وان أكثر من %68 منها كانت من محيط مدينه الفلوجة, وان غالبيه المرضى هم من الأرياف, وان الحمى وتضخم الكبد والطحال كانت موجودة في كافه المرضى المشمولين بالبحث, والشحوب في %96.6 وانتفاخ البطن وفقدان الشهية في %84.4 والسعال في %75 من الحالات. اختبار ارتشاف نقي العظم كان ايجابيا في %53.1 من الحالات وتحليل )ايفات( كان ايجابيا في %93.8 من الحالات. كافه المرضى عدى طفل واحد استجابوا لعلاج البنتوستام (ستيبوكلوكانات الصوديوم) بجرعة 15 ملغرام لكل كيلوغرام من وزن الطفل يوميا ولمده 21 يوما.الاستنتاج: الحمى السوداء هي مشكله صحية في محافظه الانبار وخصوصا الأرياف المحيطة بمدينتي الفلوجة والرمادي وأكثر انتشارا بين الأطفال الرضع والأطفال دون سن الثلاث سنوات. استخدام المبيدات لأباده حشره ذبابه الرمل (الحرمس) واستخدام العازل الغربالي للشبابيك والتثقيف الصحي حول طبيعة وخطورة المرض ودور الكلاب وابن آوى وحقول الدواجن والمجازر القريبة من المناطق السكنية من اجل معالجتها سيساعد في خفض معدل انتشار هذا المرض القاتل بدون علاج.

Keywords

kala azar


Article
Study of visceral leishmaniasis (kala-azar) in children of Iraq

Author: Sadiq M. Al-Hamash
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2012 Volume: 11 Issue: 2 Pages: 15-19
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Leishmaniasis is a parasitic disease caused by a Leishmaniaspecies, transmitted to humans through bites of female sand fly and isendemic in Iraq.Aims: To study the epidemiological, clinical, diagnostic and therapeuticaspects of visceral leishmaniasis in Iraqi children.Patients and Methods: This was a retrospective study done on patientswith Kala-azar admitted to Welfare Child Hospital-Medical City fromOctober 2004 to September 2005. The diagnosis was based onserological test and/or bone marrow exam. For each patient thefollowing data were reviewed: age, sex, time of admission, signs,symptoms, laboratory investigations and treatments.Results: A total of 50 visceral leishmaniasis cases were included. Allpatients were in the age range 0-10 years. Most cases occur in winter70%. Fever was recorded in 100%, splenomegaly in 92%, hepatomegaly in80%, and pallor in 70% of cases. Concomitant conditions were frequent:34% of cases had cough; jaundice was present in 26%; diarrhea in 18%;vomiting in 12% whereas lymphadenopathy was present only in 1% ofcases. Sodium stibogluconate (pentostam) was most often prescribedmedication (86% of cases) while miltefosine was less prescribed (14% ofcases).Conclusions: in Iraq, kala-azar should be suspected in any patient withprolonged fever and/or hepatosplenomegaly with pancytopeniawhereas in case of presence of lymphadenopathy the kala-azar would bethe last possible differential diagnosis. Also Pentostam remains the mostcommon prescribed medication for kala-azar in our country.


Article
An Epidemiological study of kala- azar in Welfare hospital for children in Baghdad
دراسة وبائية لداء اللشمانية الاحشائية في مستشفى حماية الطفل التعليمي في بغداد

Authors: Waleed AT Al-Ani وليد عارف --- Ataa AH Mousa Al-Rubaiy عطا عبدالحسين
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2007 Volume: 20 Issue: 4 Pages: 442-445
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Abstract:Background: Leishmaniasis is a major health problem worldwide. It is also a particular problem in the rural areas of Iraq Objective: To determine an epidemiological feature's of group of Kala-azar patients attending welfare hospital for children in BaghdadMaterials & Method: A retrospective study was conducted in the Welfare hospital for children, starting on October 1st 2004 and ending on April 2005. The study included all children with amastigote-positive smears in bone marrow or in splenic aspirates, or a positive Leishmania sp immunofluorescence assay. Descriptive statistics included the use of frequencies and relative frequencies. The chi-square statistical test was used to test for associations between variables with results being considered as statistically significant when the p value was <0.05.Results: The prevalence of Kala – azar was 1.02% of total patients admitted in the Welfare hospital during the period of the study. There was a distinct male preponderance with a male:female ratio of 1:5 :1. The age range of patients at the time of the study was 1- 9 years. Significantly most of cases (more than 65%) were from rural area compared with 34.3% from urban area. The percentage of males in the sample were more than females in the age group (2 -3, 6-7) years while the percentage of females were higher than males in the age group (<1 year). The highest percentage of cases occurs in February (24.07%) and lowest percentage in April (0%). The commonest presenting features were fever (55.6%), paller (27.8%), and splenomegally (16.6%). Of hosptilized patients, 66.7% stayed in the hospital for one month , 25.9% for two months and 7.3% for three months. The main outcomes were 27.8% of the patients developed complications, 65.5% alive, and only 6.4% were died.

الملخص تمهيد: داء اللشمانية الاحشائية هواحد الامراضالمتوطنةالمهمةفي العراق هدف الدراسة: تحديد الخصائص الوبائية للمرضى المصابدين بداء اللشمانية الاحشائيةطرق العمل :عبر دراسه أسترحاعية تضمنت المرضى المصابين بداء اللشمانية الاحشائية في مستثمفى حماية الطفل التعليمي في بغدادالنتائج: حيث بلغ عددالمرضى المصابين بداء اللشمانية الاحشائية في سنة 2003 (108). اصابة (65) ذكور و(43) !ناث وكانت اعمار المرضى تتراوح ما بين (3) اشهر (9) سنواث وكانت اغلب حالات الاصابة بالمرض من المناطق الربفبية حيث ثجاوزت65%اويقابلها 34.3%فى المدينة . وكانت النسبة المئويةللاصابة بأ بالمرض في الذكور اعلى منها في الإناث فىالعينة يينما كتث النسبة المثوية الاصابةيالمرض بالنسبة للاناث اعلىمن الذكور في الاعمار الثي ثثراوح من (3) اشهر الى( ا) سنة وكانث اعلىنسبة للاصابة بالمرض قد حدثت في شهر شباط والثي بلغت 7 .24 ولأ اصابه حدثت في شهر نيسان الاستنتاجات : نسبة شيوع المرض في الدراسه هي 1.02% . اغلب الحالات من المناطق الريفية ، اعلى نسبة حدثت في شهر شباط ولا اصابه حدثت في شهر نيسان

Keywords

Kala-Azar --- lieshmania


Article
Evaluation and Comparison of Immunchromatography and Immunofluorescent Techniques in Diagnosis and Epidemiological Studies in Iraqi Kala-Azar.

Authors: Mohammed F. Al-Timmimi --- Sami Y. Guirges --- Abdul Rahman A. Al-Tae
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 285-290
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Infantile kala-azar is an endemic protozoal disease prevalent among children in Iraq. A rapid diagnostic laboratory tests are required for immediate treatment.OBJECTIVE:A prospective study was conducted in two pediatric hospitals in Baghdad during the period from Oct. 2005 to Sept. 2006 to evaluate the efficiency of immunochromatography strip test (IC) with rK39 antigen compared to indirect fluorescent antibody test (IFAT) for serodiagnosis of visceral leishmaniasis (VL) to investigate its use for epidemiological studies in Iraqi kala-azar.PATIENTSAND METHODS:The study included 54 proved cases for Leishmania donovani (L.D.) bodies in bone marrow, 108 clinically diagnosed cases, 38 with diseases other than VL (tuberculosis, acute amoebic dysentery, urinary schistosomiasis, brucellosis, toxoplasmosis and malaria) and 24 healthy controls. In addition of 3000 patients presented with fever, anaemia and hepatosplenomegaly.RESULT:The highest sensitivity of the sera was obtained by IC (92.6%) and by IFAT (96.3%), and the highest specificity by IC (100%) and by IFAT (86.8%). In the epidemiological study with rK39 strip test 66.1% positive reactions were obtained in patients with fever, anaemia and hepatosplenomegaly.CONCLUSION:IC strip test with rK39 antigen was more easy to perform but less sensitive than IFAT and the former was more specific than the latter


Article
Optimum Conditions Of 5-Nucleotidase Activity In SeraOf Kala¬Azaric Patients.

Author: Eaman A.S. AL-Rubaee *,
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2006 Volume: 48 Issue: 3 Pages: 331-334
Publisher: Baghdad University جامعة بغداد

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Background: This research focuses on the characterization studies of 5v-Nucleotidase (5'-NT) of kala-azar patients' sera. 5V NT is one of the enzymes used as indicator of liver function test . In this study the optimum conditions for the activity of 5s - NT enzyme has been demonstrated for kala- azaric patients.
Materials and methods: Thirty five blood samples were obtained from Baghdad Hospitals from untreated infants and children with kala-azar. 5'-NT activity was measured by following the method of Wood and Williams.Results: Optimum conditions of serum 5' - NT activity of kala- azaric patients obtained were 50 u L , 30 minutes ,0.8 mM,7.7 and 50'C) as (Volume of serum , incubation time , substrate concentration, pH and temperature) respectively


Article
The validity of Kala-azar rapid detection test in the laboratory diagnosis of visceral leishmaniasis in Baquba

Authors: Abdul-Razak SH. Hasan --- Zainab H. Al-Azawi --- Ammar Riyadh Qasem
Journal: Diyala Journal For Pure Science مجلة ديالى للعلوم الصرفة ISSN: 83732222 25189255 Year: 2011 Volume: 7 Issue: 4 Pages: 47-53
Publisher: Diyala University جامعة ديالى

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Background: visceral leishmaniasis is the most severe form of leishmaniasis. The diseasecaused by protozoan parasites of the Leishmania genus. It is the second-largest parasitic killerin the world, being responsible for an estimated 500,000 cases each year worldwide.Objectives: To explore the validity of rapid detection test for the laboratory diagnosis ofvisceral leishmaniasis against the conventional blood smear technique.Patients, materials and methods: The present study was carried out at Al-Batoul TeachingHospital during the period from January to July 2009. A total of 75 patients with VL wereincluded. 28 (37.3%) of them were female and 47(62.7%) were male. The age range was 1month- 8 years. Additionally, 30 apparently healthy individuals were enrolled as controlgroups. 13(43.3%) of them were female and 17(56.7%) were male. Venous blood samplewere collected from each subject; sera were separated and kept frozen till use. All sera weretested for anti-rK39 IgG antibodies using the InBios Kala-azar detect rapid test (Seattle, WA)according to the manufacturer's protocol.Results: The results showed that out of 75 patients, 10 (13.3%) and 9 (12%) were positive forkala-azar by microscopical blood film examination and kala-azar rapid screening testrespectively. The distribution of positive cases according to the gender revaled hat theinfection rate among males was higher than in females, and the most affected age was 1-4years.Conclusion: The validity of kala-azar rapid setection test was comparable to that ofmicroscxopical examination for detection of kala-azar cases among clinically suspectedpatients.


Article
Visceral Leishmaniasis Complicated By Secondary Bacterial Infections in Iraqi Kala-azar

Authors: Abdul Rahman A. Al-Tae --- Sami Y. Guirges --- Mohammed F. Al-Timmimi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 2 Pages: 135-139
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Kala-azar is a vector borne parasitic disease endemic in Iraq. This disease is complicated by secondary bacterial infections which may lead to death.OBJECTIVE:The study was carried out to detect the bacterial infections associated with kala-azar and the effective treatment.MATERIALS AND METHODS:Collection of blood, urine, stool and ear exudate specimens from 63 proved kala-azar patients. The bacterial isolates from the specimens were subjected to antibiotics sensitivity test.RESULTS:63 (46.7%) of 135 hospitalized children with visceral leishmaniasis, developing 102 episodes of infections. The sites of these infections were urinary tract 46(45.1%), lower respiratory tract 37(36.3%), gastrointestinal 10(9.8%) and middle ear 9(8.9%). Both Gram negative and Gram positive bacteria were isolated. Most of the isolated bacteria belong to the family Enterobacteriaceae. The antibiotics gentamicin, amikacin and co-trimoxazole were the most effective.CONCLUSION:Bacterial infections were common among hospitalized children with kala-azar. The commonest were Gram negative bacteria of the family Enterobacteriaceae.


Article
دراسة بعض المؤشرات الدموية والكيموحيوية في الاطفال المصابين بالحمى السوداء في بغداد

Author: هناء كامل حمد
Journal: Al-Nahrain Journal of Science مجلة النهرين للعلوم ISSN: (print)26635453,(online)26635461 Year: 2014 Volume: 17 Issue: 2 Pages: 41-44
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

شملت الدراسة الحالية 82 طفل مصاب بداء الحمى السوداء المؤكد تشخيصهم بواسطة أختبار Dipstick(rK39)Immunochromatography Test- والمراجعين لمستشفى الطفل المركزي ومستشفى العلوية للاطفال في بغداد ابتداءاً من كانون الثاني 2012 ولغاية حزيران 2013 تراوحت اعمارهم من (4 أشهر- 6 سنوات) ومن كلا الجنسين، لوحظت اغلب الاصابات دون السنة الثانية من العمر والذين يعانون من نقص عدد كريات الدم البيضاء leucopenia وانخفاض في كميةخضاب الدم Hb))Hemoglobin مع زيادة في معدل ترسيب الدمErythrocyte Sedimentation rate (ESR)، كما أظهرت الدراسة زﻴﺎدة في تركيز Bilirubin وزﻴﺎدة ﻓﻲ إﻨزﻴﻤﺎت الكبد كأنزيم AspartateAminotransferaseAST)) وانزيم Alanine Aminotransferase(ALT) في ﺒﻌض ﺤﺎﻻت اﻹﺼﺎﺒﺔ الشديدة.

The current study included 82 children infected with Kala azar certainly diagnosed by Immunochromatography Test- Dipstick(rK39) and Auditors the hospital baby Central and AL-Alwiyah Children in Baghdad from(January2012 to June2013) ranged in age from (4 months - 6 years) and both sexes, observed most of the injuries less than two years old, and those who suffer from leucopenia and a reduction in the amount of hemoglobin(Hb)with the increase in (ESR) Erythrocyte sedimentation rate , the study also showed an increase in Bilirubin andan increase in liver enzymes, such as Aspartate Aminotransferas (AST), Alanine Aminotransferase (ALT) in some severe cases.


Article
A comparative study of effectiveness of diagnostic tests (r K39 strip, IFAT and bone marrow stained smear) for visceral leishmaniasis.

Authors: Mohammed J.Al Tama --- Baqur A. Sultan بكر علي سلطان --- Mohammad A. Al faham محمد الفحام --- Raad A. Al sady رعد السعدي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2011 Volume: 53 Issue: 1 Pages: 69-71
Publisher: Baghdad University جامعة بغداد

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Abstract


Article
Validation of Kala-azar diagnostic tests in a pediatric teaching hospital in Baghdad
صحة الاختبارات التشخيصية للحمى السوداء في مستشفى تعليمي للأطفال في بغداد

Authors: Muhi K. Al-Janabi محي كاظم --- Nadia A. Nasir نادية عزيز --- Ammar A. Hameed عمار عبد الحميد
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2014 Volume: 56 Issue: 3 Pages: 264-267
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Kala-azar is an important parasitic disease that affects children of all age groups with fatal outcome if left without treatment.Objectives: Children admitted with Kala-azar were studied for evaluation of Indirect Immunoflorescent Antibody Test and Bone Marrow examination validity.Patients and methods: A cross-sectional study was conducted on 60 children with Kala-azar admitted to Children Welfare Teaching Hospital - Medical City - Baghdad, for the period from the 1st of January 2011 to the 1st of February 2012. Information was obtained for each child including age, sex, residence, signs and symptoms, laboratory investigations and diagnosis was established by serology and/or bone marrow examination. Treatment and outcome were also noted.Results: The majority (94%) of studied children were less than 5 years age group. Males were more than females with a ratio of 1.63:1. Sixty percent of patients were from Diyala governorate and 23% from Baghdad. The main clinical features were prolonged fever and hepatosplenomegaly (100%). Bone marrow examination was positive in 45% of suspected Kala-azar cases. IFAT was positive in 47(78%). IFAT sensitivity was 70% and specificity 15%. All cases were treated with Pentostam (sodium stibogluconate). No resistance to Pentostam treatment was detected. The case mortality rate was 2%.Conclusion: The highest sensitivity in laboratory diagnosis among studied children was that obtained with a combination of bone marrow aspirate direct examination and IFAT. Conventional methods for diagnosis of visceralLeishmaniasis are still indispensable.Keywords: Validity, kala-azar, diagnosis, Baghdad

الخلفية: الحمى السوداء هو مرض طفيلي مهم يصيب الأطفال من جميع الفئات العمرية مع نتائج قاتلة إذا تركت دون علاج.الاهداف: IFAT تمت دراسة الأطفال الذين أدخلوا المستشفى مصابين بالحمى السوداء لتقييم صلاحية اختبار المرضى والطرق: أجريت دراسة مقطعية على 60 طفلا مصابين بالحمى السوداء الذين ادخلوا في مستشفى حماية الأطفال التعليمي في بغداد، للفترة من 1 يناير 2011 إلى 1 فبراير 2012. تم الحصول على معلومات عن كل طفل بما في ذلك السن والجنس والإقامة، والعلامات والأعراض، والفحوصات المختبرية وتأسس التشخيص عن طريق الأمصال و / أو الفحص نخاع العظام. وتم تثبيت العلاج والنتيجة النهائية. النتائج: كانت الغالبية (94٪) من الأطفال المشمولين بالدراسة أقل من 5 سنوات من العمر. ويصيب المرض الذكور أكثر من الإناث بنسبة 1.63:1. كان 60٪ من المرضى من محافظة ديالى وكان 23٪ من بغداد. كانت المظاهر السريرية الرئيسية حمى لفترة طويلة وتضخم الكبد و الطحال (100٪). وكانت النتائج إيجابية لنخاع العظام عند السوداء. 45٪ من الحالات المشتبه الحمى هي 70٪ وخصوصيته 15٪.IFAT كانت حساسية فحص تم علاج جميع الحالات بعقار البنتتوستام ، لم يتم الكشف عن أي مقاومة للبنتتوستام. كان معدل الوفيات 2٪.الاستنتاج: أعلى حساسية في التشخيص المختبري عند الأطفال المصابين بالحمى السوداء عن طريق فحص نخاع ومازالت طرق التشخيص التقليدية من الحمى السوداء ضرورية في مكان الدراسة مباشرة مع فحص. IFAT مفتاح الكلمات: صحة,الحمى السوداء,التشخيص, بغداد

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